Healthcare Provider Details

I. General information

NPI: 1235010323
Provider Name (Legal Business Name): MARIE SOPHIA OKUBO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12345 KATY FWY
HOUSTON TX
77079-1503
US

IV. Provider business mailing address

2538 BAL HARBOUR DR
MISSOURI CITY TX
77459-7141
US

V. Phone/Fax

Practice location:
  • Phone: 281-679-5600
  • Fax:
Mailing address:
  • Phone: 304-435-9063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1407672
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: